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Tooth implant and sinus infection - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Ear, Nose and Throat Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2407 Questions
User :   Hello, I had a tooth implant inserted on the upper right side which went through into my sinus. That was nine months ago, and I have had a blocked and filled maxillary right sinus since. I did finally have sinus surgery to widen the maxillary opening 2 months ago, but I am on blood thinners and the doctor said it was bleeding a lot and he got out before going in to drain. He felt it would drain on its own. It has not. I went to another ENT who looked at my CT scan and has put me on a nasal nebulizer using three meds: Betamethasone, Vancomycin, and Amphotericin. I am supposed to use the nebulizer 3x a day, but it is very strong and I get sick - so am using 2x and sometimes 3x day. The meds causing terrible crusting in my nose and sore throat, so I also irrigate. I have been using the nebulizer for approx. 3weeks. The irrigation today caused some drainage from both sides (mostly left) with reddish/brown/gray mucus and black specks in it. The right side had whitish, clumping discharge when I blew my nose hard, with black spots. If this is indicative of a sinus fungal infection, will the medication be enough to rid my sinus of it, or must it be surgically pulled out?
Doctor :   hello
Doctor :   i am Dr here
Doctor :   give me a min please
User :   ok
Doctor :   let me go thru your query
Doctor :   may i know your age and gender please ?
User :   I am female, age 45
Doctor :   and do you have any other medical problem ?
User :   blood disorders, found 4 years ago when I developed rt leg DVT and then bilat PEs
Doctor :   any diabetes or high blood pressure ?
User :   no - actually low blood pressure
Doctor :   ok
User :   I work at a hospital and am an x-ray tech
Doctor :   ok
Doctor :   well you see
Doctor :   the medications you have been on
Doctor :   esp the antibiotics.. how long have you been taking them ?
User :   I was put on antibiotics after the first infection 9 months ago and have been on many since to no avail. I developed acchilles heel tendonitis from the levoquin usage
Doctor :   i see
Doctor :   well if have been on these antibiotics for so long then the chances of infections are less BUT at the same time from the history and the symptoms you have told me it looks like they are not working good in yoru case
Doctor :   your**
Doctor :   also do you have any fever ?
User :   off and on
Doctor :   when was the last time you went to your doc ?
User :   four weeks ago when he prescribed the nebulizer
Doctor :   ok
User :   i am supposed to take the nebulizer treatment for 6 weeks
Doctor :   well i think is your case you would require a surgical approach , which has tremendous success rate
Doctor :   you have already been on strong medications for a long time now
Doctor :   and its not recommended to be on such long duration with no results
Doctor :   surgical Debridement will be useful in your case
User :   no-one has taken a lab specimen to find out the organism..if it was fungal, from what I've read - it doesn't dissipate. Am I correct in that?
Doctor :   the drug you are taking AMPHOTERICIN is a antifungal
Doctor :   see what you have been given is what we call as BLANKET therapy
Doctor :   where a mixture of antibiotics are given to cover the maximum organisms
User :   terrible stuff, too! but that should kill it and it should drain, then...if not an endoscopic surgery...can that be in the office - or would it take a hospital OR situation?
Doctor :   and yes a culture SHOULD have been taken to PINPOINT the cause
Doctor :   it will be done in the hospital setting
Doctor :   also were any diagnostic tests taken ?
Doctor :   like X RAYS or MRI recently ?
User :   I really think that I have been caught up in the political side of things - as the first doctor was supposed to do a sinus lift and bone graft before inserting the implant -but he forgot. every doc since then really want to know as little as possible (I think) do to not wanting to point out things against their peers (small community) But as I work at the hospita, I have no interest in law suits - I just want to get better!
User :   I have had head CT's that indicate a blocked osteomeatal complex and full right max sinus (alo left ethmoid sinus infection)
Doctor :   when was it done ?
User :   the implant was placed last March 2010
Doctor :   ok you do need another one
Doctor :   soon
User :   another implant? it is still in place - they were trying to preserve it.
Doctor :   no i am saying you need to get a XRAY AND MRI
Doctor :   so that we can know the extent of damage
User :   a have an order for another sinus CT - doc wanted to have it done halfway through treatment
Doctor :   its important
Doctor :   i can understand your concern, but in my opinion you have suffered enough now
User :   I can schedule it this week. If is shows the saem?
Doctor :   and you do need to see a surgeon ?
User :   I can go back to the ENT who ordered the nebulizer treatment, the first one released me after he opened the max sinus.
Doctor :   yes
User :   If the CT shows improvement, I wouldn't necessarily need the surgery, would I?
Doctor :   no you wont
Doctor :   the MAIN AIM is to find out how is your CURRENT condition now
User :   great. Although I have not had much drainage from the right side....I just hate the thought of another surgery. I hope the meds are killing whatever. My concern was that because it is not draining, it must still be in there
Doctor :   thats why in your case the diagnostic test is must
User :   OK. thank you for the clarity. Hard to find out much in this situation. I just want to do whatever it takes to FINALLY feel better. It is hard to get up and go to work everyday when you feel tired and rundawn and have headaches
Doctor :   dont worry , things will be fine
Doctor :   i can understand your concern
Doctor :   just stay positive
Doctor :   and once the test comes the treatment will be MORE SPECIFIC
User :   ok thank you - hope you have a wonderful year in 2011!
Doctor :   you too
Doctor :   thank you so much
Doctor :   your most welcoem
Doctor :   welcome
Doctor :   take care
Doctor :   and happy new year
User :   you too. bye for now
Doctor :   good bye
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